NICU

Question 1

Congenital CMV: imaging findings

Answer 1

Peri-Ventricular Calcifications

Microcephaly. lissencephaly

Question 2

Congenital Syphillis: imaging findings

Answer 2

Long Bone Metaphysitis

Periostisis

Question 3

HSV: imaging findings

Answer 3

Encephalitiis

Question 4

Following clinical features describe what syndromes?

A. Elfin facies, irritability, and supra-valvular aortic
stenosis
B. Growth deficiency, microcephaly, developmental
delay, short palpebral fissures
C. IUGR, triangular-shaped face, clinodactyly
D. Short stature, webbed neck, pulmonic stenosis
E. Weakness, club feet, tented mouth, inadequate
respirations

Answer 4

A. Williams Syndrome 
B. FASD
C. Russel Silver 
D. Noonans 
E. Congenital myotonia/myopathy

Question 5

Oligo vs Polyhydraminio?

1) Esophageal atresia
2) IUGR
3) PUV
4) Renal Agenesis

Answer 5

1) Esophageal atresia– poly
2) IUGR –oligo
3) PUV– oligo/normal
4) Renal Agenesis– oligo

Question 6

Which CHD least likely to be picked up by newborn oximetry screening ?

Answer 6

Unbalanced AVSD

Question 7

What are the 3 shunts in fetal circulation

Answer 7

1. Ductus Venosus
UV -> IVC
2. Foramen Ovale
RA -> LA
3. Ductus Arteriosus
PA -> Ao

Question 8

What does newborn blood spot screen for ?

Answer 8

• Endocrine (congenital hypothyroidism, adrenal
  hyperplasia);
• Heme (Sickle cell, beta-thalassemia);
• Metabolic
  (galactosemia, fatty acid, amino acid and organic acid disorders);
• Cystic fibrosis

Question 9

What does newborn screening consist of ?

Answer 9

• Hearing
• Blood spot >24h
• Bili at 24 and 48
• O2 sat for CHD at 24-36h

Question 10

BPD definition

Answer 10

O2 dependence beyond 28days or at 36 wks post GA

Question 11

BPD: indications for post natal steroids

CPS

Answer 11

• not recommended in 1st week of life (for prevention)

- Consider: vent-dependant, severe CLD, low dose with taper short course (7-10d)

Question 12

PDA: clinical features

Answer 12

– Preterm: 1st – 2nd week; Term: 4-6 weeks
– Bounding pulses, initial systolic murmur LSB then
diastolic component
– CHF, tachycardia,
tachypnea, HSM, apnea, increased O2 requirements
- CXR: cardiomegaly,, pulm edema (L-R shunt)

Question 13

IVH: when to screen

Answer 13

<1500g or <31+6

Question 14

PVL: risk factors

& prognosis

Answer 14

Risk factors:
– Twin-twin transfusion
– Chorioamnionitis
– Asphyxia
– Severe lung disease
– Hypocarbia
– NEC
– Postnatal dexamethasone

Prognosis:
- CP

Question 15

ROP: who & when to screen

CPS

Answer 15

GA < 30 6/7 weeks OR
OR
Birth weight < 1250 g

At 4 weeks of age or 31 weeks corrected

Question 16

ROP: risk factors

Answer 16

Hypotension
Prolonged ventilation
Oxygen therapy
Slow postnatal growth

Question 17

ROP: treatment, what

Answer 17

• Laser photocoagulation
 (within 72hrs of Type I ROP)
• Antivascular endothelial growth factor
(Proven in Zone I)
(Possible risk of delayed ROP)
(Informed consent)

Question 18

ROP: treatment, who (Indications)

Answer 18

Zone 1 - any stage ROP with plus disease
Zone 1 - stage 3 ROP without plus disease
Zone II - stage 2 or 3 ROP with plus disease

Question 19

NEC: risk factors

Answer 19

• Prematurity
• ischemia (asphyxia, CHD, PDA, severe IUGR,
  exchange transfusions), complication
• Hirschprungs
• Infection

Question 20

Early Sepsis: Maternal RFs

Answer 20

• GBS +
• GBS UTI
• Prev infant GBS bacteria
• ROM >18h
• Mat fever >38

Question 21

HIE: Criteria for therapeutic hypothermia

Answer 21

Criteria A or B AND C
A. Cord pH ≤ 7 or BD ≥ -16 or
B. pH 7.01 – 7.15 of -10 to -16 (cord
or 1 hour gas) AND Hx of acute
perinatal event AND APGAR ≤ 5
at 10m or at least 10m of PPV
C. Signs of moderate to severe
encephalopathy

Question 22

HIE therapeutic hypothermia : temperature? Duration? Timing?

Answer 22

33-34
72h
1st 6h, ASAP

Question 23

HIE therapeutic hypothermia : complications?

Answer 23

hypotension, bradycardia,

coagulopathy, PPHN, Fat necrosis

Question 24

HIE: MRI findings

Answer 24

• Basal ganglia / thalamus / PLIC
= motor + cognitive
• Watershed areas = more
cognitive than motor

Question 25

HIE: benefits of cooling (CPS)

Answer 25

Benefits of cooling
– Risk reduction 25% combined
mortality & major NDD
– NNT 11 to prevent 1 mortality
– Risk reduction 20% NDD in
survivors

Question 26

HIE: prognosis based on severity (CPS)

Answer 26

Prognosis:
– Severe: 80% morbidity
– Moderate: 30-50% (CP,
cognition, language, visual
acuity, emotional, seizures)
– Mild: usually no deficits

Question 27

Erbs palsy- what nerves affected?

Answer 27

Upper/Mid plexus: C5-6-7

Question 28

Klumpkes Palsy- what nerves affected?

Answer 28

Lower plexus: C8-T1

Question 29

GIR formula

Answer 29

[ IV rate (ml/kg/day) x % dextrose] / 144

Question 30

Causes of neonatal thrombocytopenia?

Answer 30

– Infection: bacterial, TORCH
– Neonatal alloimmune thrombocytopenia (NAIT)
– Other maternal causes: toxemia, ITP, SLE, Drugs (hydralazine, thiazides)
– Consumption: DIC, Kassabach-Merrit (hemangioma)
– Syndromes: IUGR, TAR, Fanconi’s
– Bone marrow suppression: pancytopenia, leukemia

Question 31

NAIT: treatment

Answer 31

Severe <30: IVIG, platelets (ABO compatible, washed/Ag neg)
Moderate 30-50, no bleed: IVIG alone